Wednesday, August 15, 2007

When staying alive means going bankrupt

In our second Gut Check America vote, readers rated health care as the issue of most concern for them. After a false start in Oregon, we found reader Kathleen Aldrich, a Lompoc, Calif., resident who wrote to us about how her battle with cancer drove her to bankruptcy, even though she had health insurance. Here is her story:

LOMPOC, Calif. - Kathleen Aldrich, financially ruined by two bouts with ovarian cancer, is not who you might assume she is.She raised three kids as a single mom. She worked hard for years. She had good jobs. She paid her bills. She lived in a nice house and drove a nice car. She had a decent credit rating. She had health insurance.

Now she has a record of bankruptcy and is the embodiment of the fear that nags at millions of U.S. families: that they are but one medical calamity away from losing everything. Like Aldrich, they — and perhaps you — could be.“I didn’t do anything wrong,” Aldrich says thoughtfully, sitting in the neat, pale green living room of her tiny stucco duplex in the middle of this mostly middle-class American town. “I don’t see that I did.”

Just turned 50, tall and blond with a quick smile, Aldrich is gratefully in remission for a second time from the ovarian cancer, the No. 5 cancer killer of women. Despite “feeling like a little black cloud follows me around all the time,” she has a lot to live for, from a budding long-distance romance to a precocious 6-year-old granddaughter named Alyssa.

A cat named Jack and a great bossShe has a friendly cat named Jack, a boss she adores and a grassy park nearby where she can stroll for miles as the long summer evenings unwind in Lompoc, a flat checkerboard between the bumpy brown California hills to the east and the Pacific Ocean to the west. The town, best known for a federal lockup that has housed the likes of junk bond king Michael Milken and Nixon confidant H.R. “Bob” Haldeman, also is home to Vandenberg Air Force Base, diatomaceous earth mines and 42,000 residents.

But her life is hardly idyllic. Two years and four months after her second trip through the hell of chemotherapy, Aldrich is embarking on the painful new journey of trying to rebuild her life and her credit rating. The bankruptcy has quashed all thoughts that she might someday retire. More immediately, it has left her unable to obtain thousands of dollars of work on her teeth, which likely were weakened by the powerful anti-cancer drugs.And it has left deeper wounds of shame and guilt over having to walk away from unpaid bills after a lifetime of responsible living.

Aldrich’s situation is "asinine" but increasingly common, said Dr. Deborah Thorne of Ohio University. Thorne, co-author of a widely quoted 2005 study that found medical bills contributed to nearly half of the 1.5 million personal bankruptcies filed in the U.S. each year, said that ratio has likely worsened since the data was gathered.Bankruptcy in the light of large medical bills is “unfortunately the only choice many people have," she said. "They will never in their lifetimes pay them off.“To talk with these people again and again is so frustrating. They’re such thoughtful, kind folks who are being set up by the system we have now. What’s most appalling is they’re ashamed.”Like Aldrich, Thorne said, three-quarters of the individuals in the study who declared bankruptcy because of health problems were insured."When the illness began ... they were floored," she said. "They assumed incorrectly that if you have health insurance that you’re fine and that you’ll get the treatment that you’ll need and not have to mortgage the farm to pay for it.”

In the beginning, that assumption appeared accurate to Aldrich.She was working at a credit union when she was first diagnosed with cancer in 2001. Her employer-paid insurance covered most of her expenses as she underwent surgery and her first round of chemo, which continued well into 2002. She changed jobs later that year, carefully paying her own insurance premiums through a COBRA extended health benefits program until she qualified for the group plan offered by her new employer, a title company in Montecito, an hour down the coast.

But while she was on leave for surgery to repair hernias and a bowel obstruction caused by her first operation, she was laid off. Once more, she used the COBRA process — established by a federal law that lets employees who lose their jobs maintain their health insurance for up to 18 months by paying their own premiums. Again, her insurance paid most of the bills.Aldrich had landed a new job as a processor for a Lompoc mortgage company when her cancer returned in 2004. Though she didn't have health insurance through her employer and her COBRA benefits had been exhausted, she had continued to buy health insurance, paying $533 a month.

She underwent more surgery and returned to chemotherapy treatments at Santa Barbara Hematology and Oncology, a large medical practice in the area. As the nausea and hair loss subsided in the spring of 2005, she began to receive bills from the practice that eventually totaled more than $15,000.Where's the $7,000 cap?Aldrich was stunned, since her policy with Blue Shield of California had a $2,000 annual deductible and a co-payment schedule that was supposed to cap her maximum annual “out-of-pocket” cost at $7,000 when using a “preferred provider,” as Santa Barbara Hematology is.

Still dazed by the chemo, she said, she tried to get the bill corrected, calling both the medical practice and Blue Shield. When nothing seemed to work, she turned to her sister, Mary Beth Fisher, a registered nurse for 35 years who spent the last part of her career in administrative jobs for medical practices, handling plenty of insurance matters.

“I said, ‘I know you can get ahold of someone who can help you get through this mess,’” Fisher told MSNBC.com. In the end, though, she said all they got was the run-around from both the medical practice and Blue Shield. “It was always ‘talk to another person, put your request in through e-mail.’”

Fisher said that in her experience, case workers are available on both sides to help resolve such problems. “I was astounded that she wasn’t offered that kind of assistance or support," she said. "… It really was that nobody would talk to you.”

No help from Blue ShieldFisher believes the source of the problem was that the oncology practice had been paid more for the same services under Aldrich's previous insurance policy and did not change its billings to reflect the terms of its contract with Blue Shield, Aldrich’s new carrier. But she said Blue Shield did little to make the change clear to the doctors group.Blue Shield spokeswoman Elise Anderson said privacy laws prohibited her from even acknowledging that Aldrich is a Blue Shield client, but she was confident the company’s customer service process works well.Lynn Humphrey, administrator of Santa Barbara Hematology, also declined to discuss Aldrich’s case.

According to the sisters, Santa Barbara Hematology sent Aldrich’s case to a collection agency just a few months after the dispute began and refused to discuss the bill after that, a common practice in collections cases. Then, they say, Aldrich was dismissed as a patient for being “a pain.”The sudden severing of the relationship with the young doctor whom Aldrich still reveres as the woman who twice saved her life was particularly painful.“I was so devastated and embarrassed,” she said. “Was I a pain during chemo, the whole time? Am I a piece of crap or what?”

Fisher stated repeatedly that she was not looking for any kind of handout for her sister. Seventeen years older than Aldrich, and Aldrich’s guardian after their mother died when Aldrich was 14, Fisher said, “I told Kathleen she had a part in this." She owed money for her treatment. But not any more than $7,000, they believed.

Aldrich and Fisher say they continued trying to work the problem out with Blue Shield, the medical group and the collection agency over the next year. But on July 24, 2006, the collection agency sued Aldrich, seeking nearly $20,000 in debts, attorneys’ fees, court costs and interest. The lion’s share of the total was the $15,239.52 that Santa Barbara Hematology claimed it was owed.

A short time later, Aldrich said, a sheriff’s deputy showed up with the paperwork to attach her wages from Santa Fe Mortgage, where she is the sole employee of owner Fred Bittle, a loyal supporter throughout her ordeal who pays Aldrich more than the going rate specifically so she can purchase health insurance. The prospect of having her $3,820 in monthly pay drastically reduced to satisfy the debt was nightmarish for Aldrich.

Her bank account already had been wiped out as a result of her unemployment and periods when her medical treatments had robbed her of the ability to work full time. She also had borrowed more than $15,000 from Fisher and another sister and had no way to repay the $7,000 she agreed that she owed other than a little at a time.

Nothing in the bank“I have no savings,” said Aldrich. “I probably have 10 bucks saved. I live paycheck to paycheck.” Her No. 1 goal was to keep up with the premiums on her health insurance, and she remembers thinking, “I might as well quit my job if they’re going to garnish me because there’s no way I can make it.”

After consulting with an attorney, the sisters came away believing that the only solution was for Aldrich to declare bankruptcy. “He said, 'This is such an incredible mess that I don’t think you can afford the amount of money that it would take if we could ever figure it out,’” Fisher said.“I did not want to do that,” Aldrich said. “That is not how I was raised.” She tried to figure out how to pay the judgment, to avoid the blemish of bankruptcy any way that she could. “I was willing to drive a crappy car. I’m not very materialistic. I was even at one point looking to just rent a room somewhere to cut costs,” she said. It seemed hopeless.

So, swallowing a bit more of her pride, Aldrich borrowed $1,800 more from her sister to pay the legal and court costs for the bankruptcy. Her debts were discharged in U.S. Bankruptcy Court in April, including the $15,239.52 billed by Santa Barbara Hematology. In total, the medical group was paid more than $74,000 for Aldrich’s treatment, which got so expensive that her final round of chemo cost nearly $17,000, according to copies of billing records filed in court.A familiar situationAldrich’s attorney did not respond to MSNBC.com’s request for an interview, but a well-known California lawyer who specializes in medical insurance cases said Aldrich’s experience is not unusual.

“We see it all the time in our practice,” said William Shernoff, who said insurance companies often leave patients on their own to deal with medical providers who bill too much. “None of these carriers go out of their way to help these people. They’re just looking after their own interests, and they don’t seem to have any consumer-friendly people out there trying to assist their customers. They take the first opportunity they can to get rid of any problems, especially if it’s going to cost them money.”

Shernoff doubts that a recent announcement by the California Department of Insurance that it will score Blue Shield and other big carriers on a "healthcare report card" will do much to help consumers.

Blue Shield stands by its serviceAnderson, the Blue Shield spokeswoman, said the carrier has a clear path for handling customer problems. “On anybody’s card there is an 800 number, and you call that 24/7,” she said. "There’s a whole process. The key is you start with the customer service number, and anyone at that number should be able to help you.” Calls placed by MSNBC.com to the 800 number were answered immediately by Blue Shield representatives.Thorne, the Ohio University professor, said that a larger problem illustrated by Aldrich's case is the out-of-control nature of health-care costs and insurance. "We already spend enough in premiums and co-pays that to be asked to pay tens of thousand more for health care is asinine.”Indeed, Aldrich was paying 17 cents out of every dollar she took home for her Blue Shield policy when she ran up the disputed charges. And she recently got a “birthday card” from the insurer stating that now that she has turned 50, her monthly rate will rise to $619 — just slightly less than her $650 rent. In any year that she needs any major treatment, she’ll be liable for an additional $7,000 in deductible and co-payments, meaning that she would have to devote $14,428 — well over a third of her take-home pay — to health care.

It’s hard for Aldrich to talk about her situation without strong emotions, and some tears, surfacing. But she does not want to be seen as a pity case. She sees herself as a cautionary tale for average Americans: “It can happen to you.”

Her sister agrees, saying that the moral of this story is for people at all levels of the treatment and billing process to pay close attention to details and, especially, to listen. “They don’t realize how critical it is to be exact, what a nightmare it can be for someone else,” Fisher said.Amid the photos of family and friends, there's a sign on the wall over the TV in Aldrich's little living room. “BELIEVE,” it says, in 6-inch letters carved out of wood. And despite all that has happened to shake her faith in our health care system and doctors’ offices and insurance companies, Kathleen Aldrich still believes.

She believes in working, in getting up and going to the office every day and doing the best she can. She absolutely believes in paying her $619-a-month health insurance premium. She believes that someone is watching out for her. And she believes in love.

“I had some pretty dark times during chemo,” she recalled. “I spent a lot of time alone. I asked God, and I told him the one thing that I wanted to do was to love again, to feel how it feels to be in love and to have a companion.” She gazes fondly at a picture on a nearby table of a handsome man posing in the cab of a truck with a happy dog.

“I met Richard last year. It’s a wonderful feeling to have a companion again and look forward to the little things in life that some couples maybe take for granted. I feel pretty good about the way my life is right now.”

2 comments:

Since I am not a nice guy--There is so much more to that story that is being glossed over. I am glad that she beat cancer twice. But reading that article, I have to agree with the doctor--she would be a pain. I am certain that NOTHING is her fault.

I disagree. I've had problems with everything from mis-information from the doctor(first they said I needed pre-authorization from the insurance company for my MRI, then they said I didn't) to problems with getting test results billed correctly (One company had no record of my insurance, another had my SSN messed up). Doctors aren't much better, after a cancer scare, I had to invoke HIPAA to get my test results. These types of things happen more often than you think. It's often a problem with the office staff who are barely trained in a technical school and have no sympathy for the patient. As well as the insurance companies WHO ARE A BUSINESS. They do not care about the patient. They only care about making money. I cannot imagine anyone handling the problems I've had with getting medical bills straight, while actually having cancer. I'm only sorry this woman didn't find a lawyer earlier in the process since experience has shown that legal action is the only thing that yields results.

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I like to run, but I'm slow. I love the water even if it doesn't always love me back. And I'm still tweaking the bike.
I hate jellyfish even if they do eat mosquito larva.
James Bond movies, ice cream, and finisher's medals make life worth living.